December 31, 2004

I guess people think of New Year's as a time to start over. Make resolutions, that kind of thing. I don't. Sometimes, in a really tough year, I think of the anniversary of the event that started it as a kind of closure. So September 2001 to September 2002 was really hard. I take geopolitical events personally, and that year was the September 11 attacks and our invasion of Afghanistan and the beginning of my sense that I and people like me were at the very edge of the country, about to be kicked out completely. Which we are. It was also a year in which terrible things happened to my friends. Suicide, attacks, that kind of thing. During the year, I kept thinking about how this was a bad period, and a good period would come along at some point. At the end of September 2002, I thought maybe the next year would be better. It was. But then this year is bad again, elections and tsunamis. I don't think things will be better soon. I have the feeling that we're on a bad road right now, and not one that will turn or fork or end soon.

Of course, there will always be good times and bad times. But I think there are a lot more bad times than good times to come, right now. Climate change. A new, specially American kind of fascism. More wars, more recessions, more split between rich and poor in the US and elsewhere. Less money for education and primary health services. Unchecked HIV and flu epidemics. And all the good things happening right now - the growth of farmer's markets and experiential education and alternatives of all sorts - take a long, long time to make an impact.

December 29, 2004

I've been reading a series of posts on Alas, A Blog about fat and fatphobia. In general, I think Amp's perspective is pretty right-on: like him, I'd like to see more talk about how to make people healthy and less talk (no talk? ) about how to make people thin; like him, I think most pop science attitudes about fat are nonsense. We have social attitudes about fat and bodies (esp. women's) that are stupid and mean and stupidly, meanly enforced. But still. Something about it doesn't make sense to me.

There's all this talk among fat-positive folks about fat and weight as something genetic and uncontrollable. Certainly the many fad diets that have swept this country in the last hundred years have had almost no effect on people's weight. It looks more and more like fat and health are more or less separate and like most people's bodies have a set-point that they tend to go back to: if you starve yourself, your metabolism slows down to compensate; if you exercise a lot, you crave more food to keep you at the same weight. So most people experience their weight as somewhere between marginally controllable and completely out of their hands.

This doesn't seem to be true on the population level, though. Immigrants who move to the US tend to gain weight; the US has much higher obesity rates than the rest of the world; and I think US rates of obesity-related illnesses (e.g. heart disease) are higher than those elsewhere. It seems like, in a population, high rates of obesity are correlated with higher rates of certain illnesses. I have a couple of ideas for why this might be.

1. Rates of cigarette smoking are higher in most of Europe (all countries except Finland and Sweden)2 than in the US. Cigarette smoking usually makes people thinner, but it's a far worse public health problem than obesity. The NYT recently suggested that this was part of what happened in the US in the last 50 years. I don't know what Finland and Sweden have for obesity rates, but it would be an interesting thing to look at.

2. Food culture does ultimately affect people's weight. Michael Pollan recently had a fascinating article in the NYT Sunday Magazine about the fact that the US lacks a system for deciding what to eat, in part because in mixing traditions from elsewhere we have come up with no cohesive tradition of our own. This creates an opening for totally idiotic diet fads like Atkins (or, 100 years earlier, Kellogg's) and for fast food, with its complete nutritional void. It also means that people don't feel the need to spend a long time eating and digesting, which makes them eat in less attentive ways. We might expect that a spread of US food culture (McDonalds or 30 minute lunch breaks) to other places would affect weights there, and I think I've read that it does.

3. Pollan has also suggested that US agricultural policy, which encourages over-production of basic grains, creates a surplus of corn and soybeans that gets turned into corn oil, corn syrup, and high fat/high calorie meats, which large companies then cleverly market to US eaters. We might expect that France's agricultural policy, which supports small, traditional farmers who can't compete on the world market, would have different results, and indeed it seems to.

4. The US lifestyle is far more sedentary than lifestyles elsewhere. I grew up in a mid-sized Midwestern city. I've also lived in urban and suburban Philadelphia (for over a year), Costa Rica (briefly, and in various parts), the SF Bay Area (briefly), and I've visited a bunch of cities in the US and abroad. One of the things that makes me craziest about being in Midwestern City to visit my family is that there is nothing within walking distance. I am far more active in an average Philadelphia day, because if I want to go somewhere I walk. In Midwestern City, I don't walk anywhere. Where would I walk? The nearest set of shops is over a mile away, the nearest grocery store a good mile and a half. I occasionally exercise, but I get no activity from my daily life. And Philadelphia is one of the most car-friendly cities on the East Coast. European and Costa Rican cities seem to be even less car-friendly; more importantly, you can get to your basic necessities without driving even in smaller towns. So most people have to walk a lot more. All my evidence here is anecdotal, of course, and thus subject to my own biases.

All these theories are based on the idea that some of the same factors affect both health and weight, which is something different from saying that weight itself affects health.3 They also suggest that these factors are not completely arbitrary or beyond any kind of human control. Essentially, I think that at the population level there's some evidence that culture and social organization affect food consumption and activity levels in a way that affects both health and weight. And this makes sense: culture affects individuals in quiet, varied, hard-to-measure ways, but its effects on population are easier to measure. You can see this with sexism. It's often hard to pin down exactly how sexism has affected my life or the lives of individual people I know, except in glaringly awful incidents. But we know that sexism is still a serious problem in the US - just look at comparative pay, percentages of women in legislatures, the number of serious women candidates for the presidency in the last 10 years, and on and on.

None of this excuses the vitriolic, shameful treatment of fat people in the US, or mainstream standards of beauty that have no basis in reality (and which are often so unrealistic that the models in the images have to be digitally edited to meet those standards). But it might help people think of realistic and useful options to help people be healthier.